(a) Field of the Invention
The present invention relates, in general, to ultrasonic devices and, more particularly, to methods and devices that provide ultrasonic clamped cutting using asymmetrical motion.
(b) Description of the Prior Art
The fields of ultrasonics and stress wave propagation encompass applications ranging from non-destructive testing in materials science, to beer packaging in high-volume manufacturing. Diagnostic ultrasound uses low-intensity energy in the 0.1-to-20-MHz region to determine pathological conditions or states by imaging. Therapeutic ultrasound produces a desired bio-effect, and can be divided further into two regimes, one in the region of 20 kHz to 200 kHz, sometimes called low-frequency ultrasound, and the other in the region from 0.2 to 10 MHz, where the wavelengths are relatively small, so focused ultrasound can be used for therapy. At high intensities of energy, this application is referred to as HIFU for High Intensity Focused Ultrasound.
Examples of therapeutic ultrasound applications include HIFU for tumor ablation and lithotripsy, phacoemulsification, thrombolysis, liposuction, neural surgery and the use of ultrasonic scalpels for cutting and coagulation. In low-frequency ultrasound, direct contact of an ultrasonically active end-effector or surgical instrument delivers ultrasonic energy to tissue, creating bio-effects. Specifically, the instrument produces heat to coagulate and cut tissue, and cavitation to help dissect tissue planes. Other bio-effects include: ablation, accelerated bone healing and increased skin permeability for transdermal drug delivery.
Ultrasonic medical devices are used for the safe and effective treatment of many medical conditions. Ultrasonic surgical instruments are advantageous because they may be used to cut and/or coagulate organic tissue using energy, in the form of mechanical vibrations, transmitted to a surgical end-effector at ultrasonic frequencies. Ultrasonic vibrations, when transmitted to organic tissue at suitable energy levels and using a suitable end-effector, may be used to cut, dissect, or cauterize tissue.
Ultrasonic vibration is induced in the surgical end-effector by, for example, electrically exciting a transducer which may be constructed of one or more piezoelectric or magnetostrictive elements in the instrument hand piece. Vibrations generated by the transducer section are transmitted to the surgical end-effector via an ultrasonic waveguide extending from the transducer section to the surgical end-effector. The waveguide/end-effector combinations are typically designed to resonate at the same frequency as the transducer. Therefore, when an end-effector is attached to a transducer the overall system frequency is still the same frequency as the transducer itself.
At the tip of the end-effector, ultrasonic energy is delivered to tissue to produce several effects. Effects include the basic gross conversion of mechanical energy to both frictional heat at the blade-tissue interface, and bulk heating due to viscoelastic losses within the tissue. In addition, there may be the ultrasonically induced mechanical mechanisms of cavitation, microstreaming, jet formation, and other mechanisms.
Ultrasonic surgical instruments utilizing solid core technology are particularly advantageous because of the amount of ultrasonic energy that may be transmitted from the ultrasonic transducer through a solid waveguide to the active portion of the end-effector, typically designated as a blade. Such instruments are particularly suited for use in minimally invasive procedures, such as endoscopic or laparoscopic procedures, wherein the end-effector is passed through a trocar to reach the surgical site.
Solid core ultrasonic surgical instruments may be divided into two types, single element end-effector devices and multiple-element end-effector. Single element end-effector devices include instruments such as scalpels, and ball coagulators, see, for example, U.S. Pat. No. 5,263,957. While such instruments as disclosed in U.S. Pat. No. 5,263,957 have been found eminently satisfactory, there are limitations with respect to their use, as well as the use of other ultrasonic surgical instruments. For example, single-element end-effector instruments have limited ability to apply blade-to-tissue pressure when the tissue is soft and loosely supported. Substantial pressure is necessary to effectively couple ultrasonic energy to the tissue. This inability to grasp the tissue results in a further inability to fully coapt tissue surfaces while applying ultrasonic energy, leading to less-than-desired hemostasis and tissue joining.
A multiple element end-effector including a clamp mechanism in an ultrasonic surgical device has been described in U.S. Pat. Nos. 3,636,943 and 3,862,630 to Balamuth. Generally, however, the Balamuth device, as disclosed in those patents, may not coagulate and cut sufficiently fast, and may lack versatility in that it cannot be used to cut/coagulate without the clamp because access to the blade is blocked by the clamp.
Multiple element end-effectors include those illustrated in devices such as ultrasonic shears, for example, those disclosed in U.S. Pat. Nos. 5,322,055 and 5,893,835 provide an improved ultrasonic surgical instrument for cutting/coagulating tissue, particularly loose and unsupported tissue. The ultrasonic blade in a multiple-element end-effector is employed in conjunction with a clamp for applying a compressive or biasing force to the tissue. Clamping the tissue against the blade provides faster and better controlled coagulation and cutting of the tissue.
Although ultrasonic shears such as, those disclosed in U.S. Pat. Nos. 5,322,055 and 5,893,835 have been found satisfactory, there may be limitations with respect to their use. For example, the devices disclosed in U.S. Pat. Nos. 5,322,055 and 5,893,835 operate primarily in a longitudinal mode of vibration. End-effectors of devices that operate in primarily longitudinal mode exhibit a sinusoidally diminishing effectiveness proximally from the distal end of the end-effector. As the longitudinal excursion diminishes, the effectiveness of the end-effector diminishes. This currently limits the effective length of ultrasonic devices to a fraction of their wavelength, usually substantially less that ¼ wavelength, to stay away from the node at ¼ wavelength.